Swine Flu

I hope my kids and I have faster-than-average immunity from the H1N1 vaccine.

ViolinsMy kids’ violin teacher arranged a concert at the local nursing home.  It’s a good performance opportunity for the students, and the residents love to have visitors.  I think the staff enjoys it, too, to know that they’re not forgotten.

The day of the concert we arrived, everyone dressed all spiffy, excited to play for someone other than the family members who are obligated to attend recitals.

Before we even had the chance to unload our instruments, a staff member met us in the parking lot.  She regretted to inform us that they were in the process of closing the building to visitors because they had (at least one) case of swine flu.  Therefore, no visitors – especially school children.

Too late.  My children and I had been there the previous day.  There were a lot of residents who weren’t feeling well – enough that I commented on it.  Of course they all wanted a hug.  A few always give us a peck on the cheek.

Usually staff keeps sick people in their rooms, and I’ve come to view the nursing home as one of the places we can go where we’re least likely to be around sick people.  I was miffed that they had exposed us, and used a lot of hand sanitizer that day — I still had to breath the air, though.

If it takes the vaccine two weeks to be effective, my kids and I could end up sick since we hadn’t had that much time between getting our shots and being exposed.  Do I sound little bit concerned about this?

Everyone says that elderly people aren’t considered at-risk.  A few seniors with whom I am acquainted have been very upset that they couldn’t get the H1N1 vaccine.  From their perspective, it sounded as if the health department was expecting a particularly deadly strain of flu and instead of preventing the disease, officials would be using this as a way to trim the medicare rolls and get costs back under control.  Most of the people I’ve discussed this with hadn’t realized that they’ve already lived through this particular strain of flu, so are probably already immune.  Obviously, not all of them are.

Until now, I’ve been happy with the timing of our shots, knowing that we would be able to build immunity before sharing germs with extended family over Thanksgiving and Christmas.  Maybe those precautions weren’t enough.

But I can’t live my life in a bubble.  It’s interesting, trying to figure out the right balance.

What steps do you take to avoid being exposed to illness?
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Why I Got The H1N1 Vaccine

Until a couple years ago, I hadn’t realized that influenza can be so deadly.  When I was growing up, my parents would say, “Oh, it’s just the flu,” when one of us kids got sick.  In all likelihood, they were wrong.  You don’t wonder  if you have the flu.  When you have the flu, everyone around you knows that there is something seriously wrong.  If you feel like you “might be coming down with something” then it’s not the flu.

From the comments section of Notes From A Country Doctor’s  Sick of Flu post:

What’s scary is seeing 25 year old otherwise completely healthy people linger on ventilators for a month only to die from “just the flu”.

I highly recommend John Barry’s The Great Influenza to anyone who just doesn’t see what the big deal is about the flu.

From Musings of a Distractible Mind’s  Hype? post:

I don’t think the fear of the H1N1 is misplaced.  The normal flu kills over 30,000 people per year, and the H1N1 is expected to infect three times more people than the usual flu (for reasons I will go into in the next podcast).  The implication of this is that even if this flu is “nothing special” it will kill over 90,000.  Put in perspective, prostate cancer killed 27,000 men and breast cancer killed 41,000 women in 2008.  A “normal” potency H1N1 virus could then kill more than both of these combined.

My husband and I had the flu nearly three years ago.  It hung on… and on… and on…  We both ended up with pneumonia.  Eventually a trip to the doctor had my husband feeling better in about a couple weeks, but I was extremely sick from January until May.  After that illness my hips started hurting, and my knees, and my shoulders.  And my hands.  My feet were the worst.  When my feet touched the floor in the morning, I would cry out in pain, it hurt so bad.  Eventually I was diagnosed with a disease that will never go away.  Had I not gotten the flu in the first place, it would not have progressed to pneumonia and my immune system might not have kicked into overdrive.  The very reason for this blog might not exist if I had simply gotten a flu shot that year.

Vaccine

In spite of the deadly outcome for many people, it doesn’t necessarily follow that one ought to get vaccinated.  I know people who object to the flu vaccine because at one point someone convinced them that all vaccines are bad (ie they’re not singling out flu). Others have no objection to most vaccines, but figure that they’re young and healthy so their odds of being killed by “just the flu” are pretty slim.  Still others have fears about the safety of this particular vaccine.  From KevinMD:

Reasons for refusal include a fear of side effects, including the perception that the dead virus contained in the injectable form of the vaccine can cause disease. This is false…

Some also fear the manufacturing process, saying that the vaccine was “rushed” to production. This is another myth…

Then there are those who have no objections to vaccines or staying healthy, but in consultation with Dr. Google have heard a variety of theories in relation to this particular vaccine.  Theories that the flu-like illness is man-made and was released by the government because “the government hates you and wants to kill you.”  Or they’ve heard that the vaccine is really a biological weapon.  Maybe they’ve heard that Al Qaeda is behind the swine flu.

Sound far-fetched?  Maybe it’s more believable that PETA is behind H1N1, engineering a deadly disease in hopes that adding swine flu to bird flu and mad cow will make mankind finally realize that animals should not be eaten or made into pets.

Other theories have their basis in economics:

  • Only one company in the world makes the vaccine, but they were going bankrupt.  Facing layoffs, they chose instead to spread the disease, thus ensuring work for the company and jobs for its employees.
  • A similar theory says the same thing, substituting “surgical mask manufacturers” for “vaccine” maker.
  • Yet another story has it that TV news is going the way of print media, so “they” broke into a secret government lab, stole the virus, and used press passes to gain worldwide access, thus unleasing H1N1 on the entire planet.
  • Others even claim that doctors needed more patients to treat, therefore the medical profession unleashed this disease to create more business.

Others argue that the swine flu specifically targeted Mexico:

  • Mexico has a high percentage of Catholics, and H1N1 was unleashed to kill off this religion
  • Labor unions released H1N1 to kill off cheap labor
  • U.S. anti-immigration officials are using this as a way to close border

The above is just a sample.  There are a multitude of conspiracy theories out there.  That doesn’t make any of them true.

Is The Swine Flu Vaccine Safe?

At Mayo Clinic’s website, the answer to this question is a short:

Yes. Its nonvirus components are the same as those used in the seasonal flu vaccine, which has been tested extensively and monitored for serious reactions for several years. The only difference is that in the swine flu vaccine, novel H1N1 virus replaces the influenza A viruses used in the regular vaccine.

A more detailed article can be found at WebMD.  It addresses these issues:

    Is the 2009 H1N1 swine flu vaccine safe?
    Isn’t the 2009 H1N1 swine flu vaccine too new to trust?
    Why should I believe what government scientists say about swine flu?
    Does the H1N1 swine flu vaccine contain thimerosal?
    The 1976 swine flu vaccine wasn’t safe. Why should I trust this one?
    Do we really know what drugmakers are putting in the swine flu vaccine?

Johns Hopkins’ Arthritis Center has a video discussing Seasonal Flu & Novel H1N1 Flu Vaccinations

Information is also available at the CDC’s website:  H1N1 Q&A  and the handout your doctor will provide if you get the shot.

I’ve  chosen to reduce my chance of getting the flu by getting vaccinated.  All things considered, it seems the prudent thing to do.  When you come down with influenza, one minute you appear to be perfectly healthy, and the next thing you know, you feel like you got hit by a bus.  It is not something to mess around with.  On top of that, I am in the group of people at high-risk for complications with this disease.  Anyone who has had a bad case of the flu will do whatever they can to avoid going through the experience ever again.

Adult Immunizations

Most people realize that kids should get childhood vaccines (makes my kids hate going to the doctor because they don’t like getting shots).  Immunizations are recommended for adults, too.

Adult immunization schedules can be found at the CDC website and at WebMD (cool spreadsheet, see page 3), among other places.  My general, layman’s summary (in keeping with the autoimmune theme of this blog) is:

Three vaccines are currently recommended for all adults:

Influenza annually (IM)
If you’re taking immunosuppressants for RA, such as methotrexate, one of the TNF inhibitors, or prednisone (not sure if plaquenil or sulfasalazine count as immunosuppressants), then you should be sure to get the shot, not the nasal spray.  Also, others in your household should get the shot, not the nasal spray (sorry, kids).  The vaccine is made for three different viruses; it changes annually.  This year, the H1N1 (swine flu) vaccine is separate and also recommended.  (note – I’m a bit uncomfortable with a fast-tracked vaccine so am not sure if I’ll get the H1N1, but that’s just me)

Pneumonia every five years (IM or SC)
For the general population, the pneumonia vaccine isn’t recommended until age 65.  Those who do get the shot at a younger age should have a one-time repeat for their 65th birthday.  However, for those on immunosuppressants, the recommendation is every five years.  I had such a bad site reaction last year that I’m not sure that I wouldn’t prefer to just die of pneumonia.  My arm swelled up and turned red from my shoulder to clear below my elbow, and it lasted for three weeks.  I was miserable and sure that it was infected.  The pharmacist who gave the shot was shocked and said it’s the worst reaction he’s ever seen (but he still thought it was not infected).  If I get another shot in four years, it will be in a doctor’s office on a Monday (not Thursday or Friday) so that a doctor is available to help if needed.  For another scary pneumonia vaccine story, check Leslie‘s blog.

It will be interesting to see if this recommendation changes, since a new study says, “Pneumococcal vaccination does not appear to be effective in preventing pneumonia, even in populations for whom the vaccine is currently recommended.”  Read Efficacy of Pneumococcal Vaccination in Adults: a Meta-Analysis at MedScape for more details.

Tetanus every ten years (IM)
Nobody wants lockjaw.  I have friends who won’t get their kids immunized, but even they go in for an injection whenever their kids get a puncture wound.

Three vaccines are contraindicated.  I wonder if it would make sense to discuss discontinuing immunosuppressants long enough to get any needed vaccines:

Shingles – (one-time dose) – contraindicated
The zoster vaccine is a live virus.  Those taking immunosuppressants should not get the shingles vaccine.
When we had extended family with shingles, we were phoned and told to stay home for Christmas instead of attending the family gathering.  The guy’s doctor told him to stay away from little kids who hadn’t been immunized for chicken pox, and since we homeschool the doctor doubted that our kids were vaccinated!  I’d be looking for a different doctor if he can’t make better judgement calls than that!
Shingles is reported to be extremely painful.  You don’t want to get it.

Chicken Pox – (two doses over 4-8 weeks) – contraindicated
The varicella vaccine is a live virus.  Those taking immunosuppressants should not get the chicken pox vaccine.
Despite numerous exposures, I have never had the chicken pox.  When I was expecting my first child, the doctor insisted that I must have had a mild case that nobody noticed.  To prove it to me, he ordered the appropriate lab work.  At my next appointment, the nurse came into the exam room, looked at the lab report, and declared (with an astonished look on her face), “You’ve never had chicken pox!”

MMR – (one or two doses over 4+ weeks) – contraindicated
Measles/Mumps/Rubella is a live vaccine.  Those taking immunosuppressants should not get the MMR vaccine.
I remember this vaccine at age 15.  Seems a bit odd for this to be on the adult immunization schedule.  Then again, I know people who don’t immunize their kids so some people will eventually need to do all the childhood immunizations as adults (if they live that long).

Four vaccines depend on your circumstances.  There is a ton of tiny print about these vaccines, so I probably missed some criteria.  Click on the CDC link above and go look at the tables, or read about the individual vaccines.  If you have questions, talk to your doctor.

HPV – women ages 9-26, three shots over six months

Hepatitis A – some food handlers, some lab workers, some foreign travellers, people adopting a baby from some foreign countries, people with chronic liver disease (2 doses over six months)

Hepatitis B – people with liver disease, people with renal disease, people who are promiscuous, people who are HIV+ (3 doses over six months)

Meningococcal – college freshmen living in a dorm (apparently if you live off-campus your first year, you’re automatically immune if you later move into a dorm?!), people with no spleen, some foreign travelers, some microbiologists

All vaccines appear to be contraindicated if you are allergic to components of the vaccine.  Just in case you couldn’t figure that out!